Summaries of health policy coverage from major news organizations

HIV can cause a rapidly progressing form of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, according to two studies published in today's issue of Neurology, a finding that "promises to resurrect a decades-old debate about whether viruses can play a role" in ALS, USA Today reports (Sternberg, USA Today, 9/25). The New York Times and Reuters report that in the first study, researchers at the Adolphe de Rothschild Foundation in Paris tested 1,700 people with HIV and neurological disorders over a 13-year period. (USA Today reports that 17,000 people were studied; as of press time, Kaiser Daily HIV/AIDS Report staff have been unable to identify which figure is correct.) In six cases, people with HIV presented ALS-like symptoms at a rate "far higher than the typical rate." The patients were treated with a regimen of HIV medications, and two patients became "entirely free of symptoms," three saw their symptoms decrease significantly and the other patient's condition stabilized (New York Times, 9/25). In the other study, a 32-year-old HIV-positive New York woman developed ALS-like symptoms, but saw her symptoms ease when she started antiretroviral treatment. "She went from walking to not being able to turn over in bed in a matter of months," Daniel MacGowen, a doctor at New York-based Beth Israel Medical Center and author of the New York study said. However, six months after beginning HIV treatment, "like Lazarus, this woman walks into the clinic wearing leg braces. She's doing great. I've never seen anything like this before," he added (USA Today, 9/25).

New ALS Treatments
The findings have given researchers new hope for treating ALS, which causes progressive muscle deterioration leading to death. Dr. Burk Jubelt of the State University of New York Upstate Medical University, who co-wrote an editorial on the findings, said that the results were "exciting news, because if this form of ALS caused by HIV is treatable, then other forms of ALS [possibly caused by viruses] may be treatable as well" (McKinney, Reuters Health, 9/24). According to MacGowan, previous studies of a possible link between ALS, which affects 20,000 people in the United States, and viruses were inconclusive, but those studies were done before the development of newer, more sophisticated research tools. The HIV patients' symptoms were not "identical to classic ALS" -- the disease progressed rapidly and there were other "subtle differences," according to researchers -- so the symptoms could represent a "newly recognized HIV complication" instead of a variant of ALS, USA Today reports. Still, HIV drugs may work against ALS, MacGowan said. Protease inhibitors, which work to prevent HIV from replicating and help certain white blood cells remain alive, may also prevent the death of nerve cells, he explained. MacGowan plans to give 40 HIV-negative ALS patients the protease inhibitor indinavir as part of a test study. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that although the studies' results are "interesting," a nerve disease should not be affected by treating HIV, as the virus does not infect nerve cells. But researchers theorize that HIV causes nerve disorders by suppressing the immune system so that other microbes that attack the nervous system can gain entrance or by "wreak[ing] havoc among crucial nerve centers in the brain" (USA Today, 9/25).

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